Solutions to Common Problems in Training Learners in General Internal Medicine Ambulatory Settings

Denton, Gerald D.; Lo, Margaret C.; Brandenburg, Suzanne; Hingle, Susan; Meade, Lauren; Chheda, Shobhina G.; Fazio, Sara B.; Blanchard, Melvin; Hoellein, Andrew R.

doi:10.1016/j.amjmed.2015.05.023

Cited by 8 publications

(6 citation statements)

References 35 publications

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“…These findings support the cost-neutral incentives recommended by the 2017 SGIM-AAIM position paper 2 and the 2019 AAIM paper. 1 High-value strategies from our survey further substantiate the proposals by AAIM-SGIM 2,10 and the American College of Physicians 5 for a core faculty model of master educators with salary support and institutional resources to teach in the ambulatory setting, lead medical educational programs, and mentor junior clinical faculty in ambulatory teaching. Interestingly, GME directors may wish to limit such intangible incentives as discounts in CME activities, conference registration, and parking because they hold less value for ambulatory faculty to teach, especially community-based clinicians.…”

Section: Specific Federal Programs Such As the Title VII Health Profsupporting

confidence: 59%

“…This position paper adds supporting evidence to the recommendations of the 2015 AAIM white paper, 10 the 2017 AAIM-SGIM position paper, 2 and the 2019 AAIM Perspectives on ambulatory faculty recruitment and engagement, 1 particularly on financial compensation, protected time, and faculty development. The strengths of this study include its large-scale national dissemination to key ambulatory academic groups and generalizability to various ambulatory faculty stakeholders.…”

Section: Discussionmentioning

confidence: 58%

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Identifying Solutions to Ambulatory Faculty Recruitment, Retention, and Remuneration in Graduate Medical Education: An AAIM Position Paper

Tolentino

Fazio³

et al. 2020

The American Journal of Medicine

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AAIM is the largest academically focused specialty organization representing departments of internal medicine at medical schools and teaching hospitals in the United States and Canada. As a consortium of five organizations, AAIM represents department chairs and chiefs; clerkship, residency, and fellowship program directors; division chiefs; and academic and business administrators as well as other faculty and staff in departments of internal medicine and their divisions.

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Section: Specific Federal Programs Such As the Title VII Health Profsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 58%

Identifying Solutions to Ambulatory Faculty Recruitment, Retention, and Remuneration in Graduate Medical Education: An AAIM Position Paper

Tolentino

Fazio³

et al. 2020

The American Journal of Medicine

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“…Some questions are directly related to the actions or inactions of the institutions. The failure to designate a professional dedicated to teaching in health institutions, the lack of strict criteria for hiring teaching professionals, and inadequate benefits for teaching are noted as important barriers to outpatient medical education 14 , 28 , 29 . Other problems are more related to governmental spheres, such as the poor distribution of doctors across territories of countries.…”

Section: Resultsmentioning

confidence: 99%

“…Thus, it is a place naturally exposed to service pressures 11 , 23 , 31 . Insufficient time for teaching, a factor often related to academic staff, as well as the requirements of health institutions, especially those with high patient demands, was found to be the most frequent and relevant barrier to outpatient medical education in several studies 2 , 5 , 6 , 10 , 11 , 15 , 18 , 19 , 20 , 23 , 25 , 27 , 28 , 29 , 31 , 32 , 34 , 37 , 38 , 39 , 42 . Moreover, one study noted that the diversity of diagnoses in outpatient clinics is a limiting factor for teaching, making it difficult to standardize the curriculum 21 …”

Section: Resultsmentioning

confidence: 99%

Barriers to outpatient education for medical students: a narrative review

et al. 2019

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ObjectivesThis study surveys medical education literature published over the last 25 years (1993–2018) to identify the factors scholars consider deleterious to outpatient teaching for medical students. MethodsThis study conducts a review of medical education literature published between 1993 and 2018 using Medline, Lilacs, Ibecs, Cochrane Library, and Scielo databases. The following search terms were utilized: “Education, Medical, Undergraduate” AND “Ambulatory Care” AND “Teaching/methods” OR “Clinical Clerkship” OR “Preceptorship.” This study focuses on papers describing deleterious factors for outpatient teaching with medical students and analyzes their results, discussions, and conclusions sections. ResultsOf the 363 articles obtained, this study selected 33 for analysis. These papers identify numerous factors as barriers to outpatient education. For didactic purposes, these factors are categorized into four barrier groups: environment-institution, academic staff, students, and patients. Academic staff-related teaching barrier was the most frequently mentioned obstacle. Intense care schedule with little teaching time was considered the most common and relevant barrier to outpatient medical education, followed by inappropriate teaching environment and inadequate supervision model. ConclusionsThere is a lack of recent literature on studies focusing on barriers to effective outpatient medical education. Factors identified as harmful to outpatient education have been pointed out by course directors, academic staff, and students in the literature. However, many of these factors remain overlooked by educators, who can use these factors to modify their academic activities for more effective results.

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“…Multiple perspective articles highlighted the need to focus on residents' schedules, emphasizing the importance of patient continuity, teams, and mentors. [70][71][72] The greatest challenges were in implementing the ACGME requirements, recruiting core faculty, and performing competency-based assessment. 68,69 Kisiel and colleagues 73 observed residents' perspectives on effective outpatient education using focus groups, finding the teacher-learner relationship to be of paramount importance.…”

Section: Program Evaluationmentioning

confidence: 99%

A Decade of Teaching and Learning in Internal Medicine Ambulatory Education: A Scoping Review

Coyle

Helenius

Cruz

et al. 2019

Journal of Graduate Medical Education

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Background Ambulatory training in internal medicine residency programs has historically been considered less robust than inpatient-focused training, which prompted a 2009 revision of the Accreditation Council for Graduate Medical Education (ACGME) Program Requirements in Internal Medicine. This revision was intended to create a balance between inpatient and outpatient training standards and to spur innovation in the ambulatory setting. Objective We explored innovations in ambulatory education in internal medicine residency programs since the 2009 revision of the ACGME Program Requirements in Internal Medicine. Methods The authors conducted a scoping review of the literature from 2008 to 2017, searching PubMed, ERIC, and Scopus databases. Articles related to improving educational quality of ambulatory components of US-based internal medicine residency programs were eligible for inclusion. Articles were screened for relevance and theme categorization and then divided into 6 themes: clinic redesign, curriculum development, evaluating resident practice/performance, teaching methods, program evaluation, and faculty development. Once a theme was assigned, data extraction and quality assessment using the Medical Education Research Study Quality Instrument (MERSQI) score were completed. Results A total of 967 potentially relevant articles were discovered; of those, 182 were deemed relevant and underwent full review. Most articles fell into curriculum development and clinic redesign themes. The majority of included studies were from a single institution, used nonstandardized tools, and assessed outcomes at the satisfaction or knowledge/attitude/skills levels. Few studies showed behavioral changes or patient-level outcomes. Conclusions While a rich diversity of educational innovations have occurred since the 2009 revision of the ACGME Program Requirements in Internal Medicine, there is a significant need for multi-institution studies and higher-level assessment.

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Solutions to Common Problems in Training Learners in General Internal Medicine Ambulatory Settings

Abstract: 2016-11-02T18:49:00

Cited by 8 publications

References 35 publications

Identifying Solutions to Ambulatory Faculty Recruitment, Retention, and Remuneration in Graduate Medical Education: An AAIM Position Paper

Identifying Solutions to Ambulatory Faculty Recruitment, Retention, and Remuneration in Graduate Medical Education: An AAIM Position Paper

Barriers to outpatient education for medical students: a narrative review

A Decade of Teaching and Learning in Internal Medicine Ambulatory Education: A Scoping Review

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